1063454445 NPI number — TROY S DICKSON M.D.

Table of content: TROY S DICKSON M.D. (NPI 1063454445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063454445 NPI number — TROY S DICKSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON
Provider First Name:
TROY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063454445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45680
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94145-0680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-344-2070
Provider Business Mailing Address Fax Number:
530-295-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 GOLDEN CENTER DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-6278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-344-2070
Provider Business Practice Location Address Fax Number:
530-295-0400
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  A79321 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)